NPI | 1679986194 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS041865) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401415159) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2014-06-03 |
Last Update Date | 2022-03-17 |